Cross-Sectional Study of Atypical Swallowing and Occlusal Characteristics in 6–16-Year-Old Patients Presenting for Orthodontic Care

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Abstract
Introduction: Malocclusion and dysfunctional or atypical swallowing are two conditions that significantly affect the health and well-being of the stomatognathic system, so much so that they often interact, influencing each other, and the presence of one can cause the onset or aggravation of the other. In this regard, over the years studies have been carried out that tried to discover the correlation between atypical swallowing and malocclusion. The aim is to evaluate the prevalence of dysfunctional swallowing in patients with malocclusion, to examine the pathophysiological mechanisms linking malocclusion and dysfunctional swallowing, and above all to investigate what potential risk factors may be. Materials and Methods: A sample of 60 patients aged between 6 and 16 years was analyzed at the Department of Dentistry of the University of L’Aquila. Some characteristics of the subjects’ face and posture were analyzed both from a frontal and lateral point of view. An orthodontic, temporomandibular joint, and masticatory muscle diagnosis was made. In addition, an examination of oral structures and functions was performed that allowed breathing, swallowing, chewing, and phono-articulation to be assessed. Results: It was observed that all the children had atypical swallowing, with significant postural abnormalities of the tongue; in fact, only 5% had a correct posture of the tongue at rest. In the analysis of occlusal characteristics, it emerged that with regard to the transverse plane, 21.67% of subjects have a condition of No Cross, while 10% show a Unilateral Cross. Finally, 68.33% show a Bilateral Cross. As far as the anterior–posterior plane is concerned, most of the subjects, equal to 76.67%, are placed in Class I, while 23.33% are in Class II. Finally, in relation to the vertical plane, 63.33% of subjects have normal occlusion, while 25% suffer from deep bite and 11.67% from open bite. The sample, stratified by presence or absence of alerts, shows significant differences for atypical swallowing (p = 0.031), for the presence of Class II malocclusion (p = 0.002), for low lingual posture, (p < 0.001), and for labial incompetence (p = 0.001). The multivariate logistic regression model showed that the presence of atypical swallowing (OR 1.04, 95% CI 1.04–1.07, p = 0.029), open bite malocclusion (OR 1.09, 95% CI 1.01–1.18, p = 0.013), low lingual posture (OR 1.11, 95% CI 1.04–1.18, p = 0.002), and the presence of labial incompetence (OR 1.06, 95% CI 1.02–1.10, p = 0.029) were significant clinical risk factors independently associated with the presence of alerts. Conclusions: The data collected confirm that atypical swallowing is a key element in the development of malocclusions, with a strong impact on posterior crossbite, anterior overjet, and other occlusal discrepancies. Among the data collected in the diagnostic phase, patients who presented at least one significant alert were also considered and atypical swallowing, low lingual posture, open bite malocclusion, and the presence of labial incompetence were statistically significant.

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